Neonatal resus Flashcards
What is primary vs secondary apnoea
Primary - rapid breahting followed by apnoea - stimulation should wake baby up
Secondary - ongoing hypoxaemic stress resulting in further apnoea. BAD
What are the two ways in which the hypoxaemic new born can struggle
FLUID - fluid in lungs. Requires squeezing through the birth canal but also then some big breaths to inflate the alveoli and draw the amniotic fluid into the pulmonary capillaries and lyphatics. If baby cannot do these big breaths might stay ith fluid in the lungs and require some rescue breaths.
BLOOD - not much blood going to pulmonary ssytem in utero because of the ductus arteriosus. At birth the higher O2 of blood constricts the ductus arteriosus. However, if baby hypoxaemic this might not happen and therefore blood still shunted away from the lungs, causing a further lack of oxygen exchange and deteriorating infant.
Where should the puse oximeter be placed?
What does it measure
HR and O2 sats
Right hand as pre-ductal
How to warm the term or pre-term infant
TERM - place under heater and dry
PRE-TERM - do not try, wrap in thermal bag with hat on. Greenhouse effect
What 3 things does the initial assessment of the newborn involve
Heart rate
Resps
Tone
Describe what the A and B involves in the resus of the newborn
Chin lift
Wipe baby’s mouth. Avoid sucction unless mec/blood/cannot clear something.
Bag valve breaths (positive pressure) if baby not breathing well enough. With 21% o2
DO NOT GIVE 100% O2
Supplemental O2 if:
- sats <70% at 5 minutes
- chest compressions
- HR still <100 despite positive pressure ventilation
What is the optimum size for positive pressure bag for all babies
240ml - Neopuff
How do you choose the size of mask for newborn resus
cover mouth and nose and reach tip of chin
how do you do positive pressure ventilation for the newborn
Put mask on. lift chin. 20-30ml inflation
Rate = 40-60 BPM
If breaths normal and HR >100 at 30 seconds can stop PPV
What are the target sats for newborns
1 minute 60%
3 minutes 70%
5 minutes 80%
10 minutes 85-90%
Indications for ET in newborn
prolonged PPV not working
suspected diaphragmatic hernia
What does C involve when dealing with an unwell newborn
Once ventilation is established, measure HR.
If after 30 seconds of PPV the heart rate is >100 bpm then likely the PPV can be stopped
Reassess HR every 30 seconds
If HR remains <100 bpm then keep going with PPV
If HR goes <60 then need chest compressions and to commense 100% O2
How to do chest compressions in the new born
3:1 ratio
90 chest compressions and 30 breaths - 120 events per minute
What to do if HR still <60 after 30 seconds CPR
drug therapy needed
Describe the NLS algorithm
